Mood Disorder Due to a General Medical Condition
DSM-IV For more information, see Mental Disorders Due to a General Medical Condition Diagnostic Criteria A'''. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following: # depressed mood or markedly diminished interest or pleasure in all, or almost all, activities # elevated, expansive, or irritable mood '''B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition. C'''. The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder With Depressed Mood in response to the stress of having a general medical condition). '''D. The disturbance does not occur exclusively during the course of a delirium. E'. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. ''Specify type: * '''With Depressive Features: if the predominant mood is depressed but the full criteria are not met for a Major Depressive Episode * With Major Depressive-Like Episode: if the full criteria are met (except for Criterion D) for a Major Depressive Episode * With Manic Features: if the predominant mood is elevated, euphoria, or irritable * With Mixed Features: if the symptoms of both mania and depression are present but neither predominates Note: Include the name of the general medical condition, e.g., Mood Disorder Due to Hypothyroidism, With Depressive Features; also record the general medical condition. Note: If depressive symptoms occur as part of a preexisting dementia, indicate the depressive symptoms by recording the appropriate subtype of the dementia if one is available, e.g., Dementia of the Alzheimer's Type, With Late Onset, With Depressed Mood. Subtypes One of the following subtypes may be used to indicate which of the following symptom presentations predominates: With Depressive Features This subtype is used if the predominant mood is depressed, but the full criteria for a Major Depressive Episode are not met. With Major Depressive-Like Episode This subtype is used if the full critera (except Criterion D) for a Major Depressive Episode are met. With Manic Features This subtype is used if the predominant mood is elevated, euphoric, or irritable. With Mixed Features This subtype is used if the symptoms of both mania and depression are present but neither predominates. Recording Procedures In recording the diagnosis of Mood Disorder Due to a General Medical Condition, the clinician should note both the specific phenomenology of the disturbance, including the appropriate subtype, and the identified general medical condition judged to be causing the disturbance (e.g., Mood Disorder Due to Thyrotoxicosis, With Manic Features). The general medical condition should also be noted (e.g., thyrotoxicosis). A separate diagnosis of Mood Disorder Due to a General Medical Condition is not given if the depressive symptoms develop exclusively during the course of Dementia of the Alzheimer's Type or Vascular Dementia. In this case, the depressive symptoms are indicated by specifying the subtype With Depressed Mood (e.g., Dementia of the Alzheimer's Type, With Late Onset, With Depressed Mood). Associated General Medical Conditions A variety of general medical conditions may cause mood symptoms. These conditions include degenerative neurological conditions (e.g., Parkinson's disease, Huntington's disease), cerebrovascular disease (e.g., stroke), metabolic conditions (e.g., vitamin B12 deficiency), endocrine conditions (e.g., hyper- and hypothyroidism, hyper- and hypoparathyroidism, hyper- and hypoadrenocorticism), autoimmune conditions (e.g., systemic lupus erythematosus), viral or other infections (e.g., hepatitis, mononucleosus, human immunodeficiency virus HIV), and certain cancers (e.g., carcinoma of the pancreas). The associated physical examination findings, laboratory findings, and patterns of prevalence or onset reflect the etiological general medical condition. Differential Diagnosis Delirium and Dementia A separate diagnosis of Mood Disorder Due to a General Medical Condition is not given if the mood disturbance occurs exclusively during the course of a delirium. When the clinician wishes to indicate the presence of clinically significant mood symptoms that occur in the context of a Dementia Due to a General Medical Condition, a separate diagnosis of Mood Disorder Due to a General Medical Condition can be indicated. An exception to this is when depressive symptoms occur exclusively during the course of Dementia of the Alzheimer's Type or Vascular Dementia. In these cases, only a diagnosis of Dementia of the Alzheimer's Type or of Vascular Dementia with the subtype With Depressed Mood is given; a separate diagnosis of Mood Disorder Due to a General Medical Condition is not made. If the presentation includes a mix of different types of symptoms (e.g., mood and anxiety), the specific mental disorder due to a general medical condition depends on which symptoms predominate in the clinical picture. Substance-Induced Mood Disorder If there is evidence of recent or prolonged substance use (including medications with psychoactive effects), withdrawal from a substance, or exposure to a toxin, a Substance-Induced Mood Disorder should be considered. It may be useful to obtain a urine or blood drug screen or other appropriate laboratory evaluation. Symptoms that occur during or shortly after (i.e., within 4 weeks of) Substance Intoxication or Withdrawal or after medication use may be especially indicative of a Substance-Induced Disorder, depending on the character, duration, or amount of the substance used. If the clinician has ascertained that the disturbance is due to both a general medical condition and substance use, both diagnoses (i.e., Mood Disorder Due to a General Medical Condition and Substance-Induced Mood Disorder) are given. Other Mood Disorders and Adjustment Disorder With Depressed Mood Mood Disorder Due to a General Medical Condition must be distinguished from Major Depressive Disorder, Bipolar I Disorder, Bipolar II Disorder, and Adjustment Disorder With Depressed Mood (e.g., maladaptive response to the stress of having a general medical condition). In Major Depressive, Bipolar, and Adjustment Disorders, no specific and direct causative physiological mechanisms associated with a general medical condition can be demonstrated. It is often difficult to determine whether certain symptoms (e.g., weight loss, insomnia, fatigue) represent a mood disturbance or are a direct manifestation of a general medical condition (e.g., cancer, stroke, myocardial infarction, diabetes). Such symptoms count toward a diagnosis of a Major Depressive Episode except in cases where they are clearly and fully accounted for by a general medical condition. If the clinician cannot determine whether the mood disturbance is primary, substance induced, or due to a medical condition, Mood Disorder Not Otherwise Specified may be diagnosed. DSM-5 In DSM-5, this disorder is separated into Depressive Disorder Due to Another Medical Condition and Bipolar and Related Disorder Due to Another Medical Condition